Join the fast-growing startup that is changing the conversation around pharmacy benefits.

Based in San Francisco, SmithRx was founded in 2016 to create a technology-driven and cost-competitive pharmacy benefit manager (PBM) that offers clients a flexible, customer-centric product. “Our focus is on building the next generation pharmacy benefits partner that enables choice, aligns incentives, and surfaces insights to improve care delivery,” says SmithRx Founder & CEO Jake Frenz. “Innovation has lagged in the PBM sector, and our team is dedicated to accelerating change.”

SmithRx administers and manages pharmacy benefits for B2B customers so they may provide a seamless experience for employees purchasing prescription drugs. Each year, nearly half a trillion dollars flow through pharmacy benefit managers (PBMs), with three large companies controlling 75%+ market share. SmithRx offers a new path forward that aligns incentives and harnesses data analytics to deliver an exceptional pharmacy benefit product. 

The company brings together experience at from healthcare companies including Anthem, Humana, Collective Health, Castlight Health, and CVS Caremark, as well as a broader set of technology leaders including LinkedIn, Upwork, and Glassdoor to solve what we believe is one of the largest—yet least-recognized—problems in the healthcare industry.

 

Plan Operations Specialist

Reporting to the Implementation Manager, the Plan Ops Specialist will join the company’s Customer Success team to support all core Plan Ops functions ensuring the high quality of the SmithRx product.

 

Responsibilities 

  • Support all core Plan Operations functions
  • Ensure accuracy of claim adjudication through implementation testing and monthly claims audits
  • Build, test, and audit benefit designs and eligibility loads during implementation
  • Conduct regular cadence claims auditing to ensure accuracy, including thorough review of complex claims
  • Identification of plan build and / or adjudication errors with recommendations for solutions
  • Troubleshooting eligibility questions, claim adjudication, accumulator workflow processes, 
  • Assist Member Support on benefit design and adjudication inquiries
  • Coordinate and collaborate with resources across all adjacent organizations including but not limited to Strategy, Engineering, Clinical, and Plan Operations
  • Manage review and resolution of eligibility issues by working cross-functionally
  • Partner closely with SmithRx Implementation Manager to support all processes during onboarding of new accounts by working cross-functionally to resolve key issues that may arise

 

Qualifications

  • Track record of high-performance and passion for learning and problem solving
  • Knowledge of pharmacy benefits and claims adjudication a plus 
  • Ability to learn and document complex concepts
  • Advanced level skill and experience with Excel
  • Basic level skill and experience with MySQL
  • Critical thinker who is very detail oriented
  • Excellent interpersonal, written & verbal communication skills
  • Ability to multi-task, prioritize, and deliver in a demanding and constantly changing corporate environment
  • Maintain open lines of communication with other functional areas/departments

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